Asthma and COPD Flashcards
What do both Asthma and COPD have in common?
These are both obstructive airway diseases.
Which diagnostic test allows us to tell the difference between obstructive and restrictive disorders?
Spirometry -FVL reveals it especially.
Cannot blow out as much (VC)
Describe Allergic Asthma
Atopy and asthma attacks specific to an allergen
Describe Non-Allergic Asthma
No history of allergy/allergen trigger
What is allergic asthma characterised by?
-Increased serum IgE
–> An allergen-specific IgE and Eosiniphilia
What is all asthma characterised by?
-General airway hyperreactivity to non-specific irritants such as smoke cold air etc
Name some triggers for asthma
- House dust mites
- Domestic pets
- Fungi
- Exposure to occupational chemicals
What is COPD a blanket term for?
Emphysema and Bronchitis
How does COPD affect the body?
- Decreased airflow that is not fully reversible
- Breathlessness can progress over years to chronic hyppoxaemic or hypercarbaric respiratory failure
Define emphysema
A disease of destruction in distal airways and lung parenchyma
- Causes alveoli to be destroyed decreasing SA of lung
- Lungs often lose elasticity
Define Bronchitis
A condition of large airway inflammation and remodelling
Describe Emphysema (4)
- Airspaces distal to the terminal bronchiole become enlarged
- Alveolar walls and capillaries are destroyed
- Tissue destruction causes Ventilation-Perfusion mismatch
- Permanent EFFECTS
How can you view the destroyed alveolar walls?
High Res MRI and CT imaging
Describe Bronchitis
- Persistent cough
- Sputum production > 3 months of the year for >2 years
What occurs at a cellular level with Bronchitis?
- Neutrophilic inflammation driven by CD8+ T cells
- Peribronchial fibrosis
- Increase in airway smooth muscle
- Airways will be occluded by mucus
What can make COPD progress?
- Smoking
- Atmospheric Pollution
- BUT not everyone who smokes gets COPD
- COPD progresses in some people who give up smoking
In what ways do COPD and Asthma merge?
inflammation involves neutrophils
and Th1 lymphocytes
In what ways do Asthma and COPD merge?
- 10% of COPD patients have reversible bronchoconstriction (like asthma)
- These COPD patients have elevated numbers of eosinophils (like asthma)
- These COPD patients respond well to corticosteroids (like asthma)
What is the goal with treatment for both?
Improve Qol and prevent exercabations
What is a key feature of pharmacotherapy?
It is stepwise so it has step downs and steps up to match the patients needs
What does asthma treatment involve?
- ‘Relievers’ (Such as Beta agonists)
- ‘preventers’ (such as inhaled corticosteroids)
- often a combo therapy
What does COPD treatment involve?
-Initially long acting beta agonists (LABAS) or long acting muscarinic antagonists (LAMAS)
What inhaler for Asthma?
pMDI metred dose inhalers
such as Ventolin
beta 2 agonist
What inhaler for COPD?
Dry powder (DPI) LAMA for COPD
Such as Breezhaler
Muscarinic Antagonist
Combination inhalers for asthma?
Combination Dry Powder Inhalers
- Seretide/Accuhaler
- Symbicort
Long-acting Beta 2 agonist
Corticosteroid
Dry Powder for COPD?
LABA/ICS
Dry Powder LABA/ICS
BREO
B2 agonist
Corticosteroid
Dry powder for COPD?
LAMA/LABA/ICS
Three drugs:
Trelegy
Are any treatments Curative?
No
What must occur at same time as pharmacotherapy?
Smoking Cessation
What new introduced therapies are there for severe asthma?
Monoclonal Antibody Treatments (anti-IgE and anti-cytokine)
-Injected and expensive
